Results 1 to 3 of 3
  1. #1
    Join Date
    Apr 2018
    Posts
    3

    Default MSA and Medical Bills

    Once a case is settled with MSA I know that the claimant has to use the MSA only for injury related medical expense. But I also read that Iím allowed to only pay discounted or the insurance rate to Physician & medications , not any higher. But how does a lay person know how much does insurance or WC pays for physicians & pharmacy & how do they suppose us to negotiate it with them if MSA is self administratered ? TIA

  2. #2
    Join Date
    Oct 1971
    Posts
    5,193

    Default Re: MSA and Medical Bills

    Quote Quoting Annie74 View Post
    Once a case is settled with MSA I know that the claimant has to use the MSA only for injury related medical expense. But I also read that I’m allowed to only pay discounted or the insurance rate to Physician & medications , not any higher. But how does a lay person know how much does insurance or WC pays for physicians & pharmacy & how do they suppose us to negotiate it with them if MSA is self administratered ? TIA
    Where did you read that?
    You should post the source when referencing info.

    That's not true, you're considered on a cash pay basis - you're not in their network so you don't qualify for their discount.
    It doesn't matter how much you pay as long as you exhaust the MSA on medical associated with your work related injury, at that point Medicare will kick in.
    Be aware, Medicare only pays a percentage, they don't pay the entire bill - you'll still have co pays, etc.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Apr 2012
    Location
    Ohio
    Posts
    120

    Default Re: MSA and Medical Bills

    Quote Quoting Annie74 View Post
    Once a case is settled with MSA I know that the claimant has to use the MSA only for injury related medical expense. But I also read that Iím allowed to only pay discounted or the insurance rate to Physician & medications , not any higher. But how does a lay person know how much does insurance or WC pays for physicians & pharmacy & how do they suppose us to negotiate it with them if MSA is self administratered ? TIA
    If you have a self-directed MSA you likely will not get any discounts. But if your MSA is being "serviced" by someone (this often happens for large MSA's) they would negotiate the bill and handle this as if they are your health insurance.

    I presume (and hope) that the settlement was done through an attorney so I would direct you to ask him/her about this for specifics on your claim and how the MSA will be set up.
    Kristin A. Cool
    Ohio Workers' Compensation Attorney
    Practicing in Northeast Ohio, Central Ohio, and Mahoning Valley
    www.TheFriedmanLawFirm.com
    Workers' Compensation Blog

Similar Threads

  1. Payment of Medical Bills
    By mozart in forum Insurance Company Practices
    Replies: 3
    Last Post: 05-04-2011, 01:40 PM
  2. Getting Medical Bills
    By A R in forum Pennsylvania
    Replies: 3
    Last Post: 03-06-2009, 05:21 AM
  3. Payment of Medical Bills
    By tibcrusher in forum Medical Issues
    Replies: 0
    Last Post: 02-02-2009, 08:48 AM
  4. IC Responsibility for Medical Bills
    By injuredonjob in forum Illinois
    Replies: 4
    Last Post: 01-18-2009, 06:12 AM
  5. Medical Bills
    By seesaw28 in forum Pennsylvania
    Replies: 1
    Last Post: 01-17-2009, 05:51 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer